Disclaimer: Throughout this article, we will be using the term “woman” to describe biological females who can become pregnant. We understand that sex and gender are separate, but for the sake of simplicity and consistency, these are the terms we will be using. If you would like to learn more about gender identity, visit our Sexual Orientation Gender Identity article.

If you or someone you know is seeking an abortion, there are several factors to consider when choosing a clinic. Namely, it is important to ensure that the health care provider is medically certified to provide an abortion, the clinic does not have any hidden moral agenda, and the facility is a sterile environment suitable for medical practice. Although abortion is both a safe and legal way to terminate pregnancy in all American states, the availability of abortion services varies widely across the nation. When searching for a clinic, you need to be aware that not all abortion facilities are equally accommodating, and you may need to travel some distance to receive the best, most affordable care. Generally, a good abortion clinic is one that provides dignified and professional physical, mental, and emotional care.1

Medical Certification

Perhaps the most important criterion for choosing an abortion clinic is verifying that it employs licensed physicians and nurses who are certified to perform abortion procedures. In the United States, this means an abortion practitioner must have a standard physician’s license per regulation (at the state and federal levels) and any assisting nurses must also have the required state licensing. In the United States, the abortion practitioner should be a licensed doctor and any assisting staff should be Licensed Vocational Nurses (LVNs), Registered Nurses (RNs) or Physician Assistants (PAs). Licensing may vary by state, so more information can be found in the public records for each state’s Department of Health Services (or their equivalent department).

In 1994, the Accreditation Council for Graduate Medical Education (ACGME) started to require obstetrics and gynecology residency programs to at least allow residents to access training to perform induced abortions. In a statement updating the requirements on residency training released in June 2017, ACGME clarified that the previous requirements must be upheld and that residents must also be trained to manage any complications from abortion procedures.2 Only 61% of residency programs reported that the required abortion procedure training was routinely provided and 32% reported that it was available or optional for the residents.3 The number of abortion clinics nationwide has declined over recent years due to the dwindling number of abortion-practicing physicians and the general rise in cost of abortion procedures. This, in addition to varying legislative restrictions4, has led to an overall decrease in licensed abortion procedures by about 8%.5

Perhaps the most influential reason for the decline in legal abortion rates is the shrinking number of clinics and health care providers available to those seeking abortion. It is believed by women’s health experts that the actual number of abortions performed each year is unknown due to the decrease of professional practicing clinics and increase in unsafe, non-clinical abortions. Many laws which are introduced to improve the quality of care are actually aimed at shutting down clinics and make it harder to keep them open and accessible. Historically, many women in regions where abortions were unavailable (because they were illegal or highly stigmatized) sought abortions from non-licensed persons in whatever conditions the procedure was available.5

In areas of the world where abortions are unavailable in medical facilities, as many as 20 million unsafe abortions are performed on a yearly basis. The results of unsafe abortion practices are clear: each year, approximately 68,000 women die, and millions more experience complications that compromise their health temporarily or permanently.5

Hidden Moral Agendas

Although a majority of Americans polled in 2017 believe abortions should be legal in all or most circumstances (57%), there is still a large portion of Americans who believe abortions should be illegal in all or most circumstances (40%).6 Recently, there has been a growing trend towards “conditional acceptance” in which abortions are considered acceptable in cases of rape, incest, endangered maternal or fetal health, or strong indications of defects in the developing fetus. Most importantly, when given the freedom to choose on a continuum of the abortion debate, a vast majority of Americans fall somewhere in the middle of the two extremes.6

Those who identify as unconditional pro-life supporters typically do not follow such trends and fall on the extreme end of believing abortions should be illegal under all circumstances. They believe life begins at the moment of conception and that removing a developing fetus from the womb is equivalent to murder. Some groups and organizations who oppose abortion pose as willing providers to lure women seeking information on abortion into conversations with the goal to sway the women away from obtaining an abortion. Due to pro-lifers’ extreme opinion and the fact that they have been violent, some doctors who are willing to and capable of performing abortions refuse to do so out of fear of harassment or violence. However, some states have protections for the doctors and clinics. These protection laws prohibit obstruction, threat or damage of the clinic and its staff and can also create a zone around the clinic in which it is illegal to protest.7

Women seeking a reputable clinic, for information or a procedure, should be cautious of facilities where clinicians do the following:

Give free pregnancy tests and ambiguous answers to any questions about the clinic.

Show shocking films and handouts designed to scare women away from abortion.

Attempt to induce guilt by performing ultrasounds and personifying the fetus.

Preach their personal religious beliefs.

Clinics that actively support a woman’s right to terminate her pregnancy do not participate in any of the above activities. Reputable abortion clinics are respected, trustworthy, established facilities that encourage women, without bias, to be well-informed of all their options. Such establishments support the physical and mental health of all women, regardless of their beliefs or decisions. Certified, dignified, and professional practices will do the following:

Respect the patient’s wishes and do not subject them to unwanted procedures.

Sterile Medical Environment

First impressions matter. Upon entering any medical facility, you should have the impression that it is a clean, sterile, and organized environment. If the facility seems chaotic, unclean, or unkept, you reserve the right to leave and choose another facility. Any facility that provides medical procedures is required to abide by state and federal laws regarding the regulation of sanitation and health practices.

If you choose a facility upon a satisfying first impression but find the conditions in which your abortion procedure is being performed unsatisfactory (e.g., unclean rooms, tools, etc.), you may leave the facility at any time. If you suspect medical malpractice or unsanitary conditions, it is wise to choose another facility in which you feel more comfortable, and report the previous facility to the state’s Department of Health (or their equivalent department). Medical practices in the United States are held to strict standards regarding their cleanliness and sterility and can lose their licenses in the event of unsatisfactory inspections.

Availability by Region in the United States

The availability of abortion services across the United States varies by location. Unfortunately, one-third of all American women still live in counties without a single abortion provider, despite the fact that abortion is legal in all 50 states. Large cities typically contain plenty of abortion providers, and women are typically able to find competitively priced procedures in such areas.

In more rural areas and the middle and southern states, it is often extremely difficult for most women to find reputable abortion providers, if they find any at all. Women residing in some of these states are limited to one provider within the entire state because anti-abortionists dominate the state’s political spheres. These states often only have abortion providers in the largest city in the state.11 Many women may have to travel more than 30 miles each way or even out of state to find such a provider.8 This makes it painfully difficult for these women to find legitimate providers who support their right to choose, and oftentimes women must seek quality providers outside of their city, county or even state.

However, time and cost of travel can make it nearly impossible for women in these areas to receive a safe procedure and the proper care before and after. Many states also have requirements about a waiting period, meaning that the women would either have to stay where they travelled to for 24-72 hours and therefore take time off work and pay for a hotel, or travel back home after the first appointment and then travel to the provider a second time for the procedure or post-operation check-up.9 This poses a considerable burden for those who do not have the financial resources for either option, cannot take time off work, find childcare, pay for housing near the clinic location, or even obtain access to the transportation.10 There are many other factors which impact women in these largely rural, poor, and low-income environments.10 Additionally, the stigma associated with abortion in such areas can sometimes be enough to turn women away from the possibility of even considering the procedure.

Legality of Abortion in The United States

Under federal protection from the historic Roe v. Wade decision, abortion is currently a legal way to terminate a pregnancy in the United States. However, individual states are permitted to impose restrictions limiting the availability of the procedure. Therefore, access to abortion services may be restricted depending on one’s state of residence. Consult your state’s abortion laws to find out if it enforces any restrictions on the procedure. Examples of popular restrictions are listed below:

Age: Many states require the individual obtaining an abortion be over 18 years of age.

Parental consent: Many states require parental consent or involvement in a minors’ decision to have an abortion.

Trimester of pregnancy: Many states prohibit abortion in cases with the gestational period over 20 weeks or at viability, unless medically necessary to protect the mother’s health.

Notification of marital spouse: While not required, many states and clinics will deny abortion access if the spouse, partner or parent of the fetus is not previously notified.

A waiting period: Many states require a 24-72 hour waiting period between the first check-up in which the woman decides abortion is the right option and the actual procedure.

While abortion is federally legal under the ruling of Roe v. Wade, the restrictions put on women who would like to obtain access to abortions can severely impact the reality of obtaining a legal abortion.

In closing, abortion in the United States is both a legal and safe option for women who do not wish to carry a pregnancy to term. Although women from different regions of the country may encounter more difficulty than others in receiving an abortion, any clinic that provides abortion services should provide high quality unbiased physical and mental care, and treat all patients in a dignified manner.

To see what availabilities and restrictions there are on abortion procedures in your state of residence (U.S only), please visit the Guttmacher Institute and the Safe Place Project webpages or click the links below to see a comparison chart and map.

Canada

History

In 1869 abortion was outlawed completely, but 100 years later, through a bill proposed by Prime Minister Pierre Trudeau in 1969, abortion became legal if the mother’s life or health was at risk.12 Obtaining an abortion required the approval by a team of three doctors. The Committee on the Operation of the Abortion Law, known as the Badgley Committee, was appointed in 1975 to examine if the abortion law established in 1969 was operating fairly and impartially throughout all of Canada and if not, then make suggestions on how to improve the enforcement of the law. The Badgley Committee concluded that abortions were not available to women all across Canada due to the distribution of doctors and hospitals. The main suggestion was to prevent unwanted pregnancies by creating better family planning information and services.13

Dr. Henry Morgentaler became well known for his activism surrounding abortion from the early 1970’s until his death in 2013. In 1973, he publicly stated that he had performed many abortions outside of the legal three-doctor proceeding. During the 1970’s Dr. Morgentaler was charged and acquitted multiple times for providing illegal abortions. In 1983 he opened clinics to provide abortions in both Winnipeg, Manitoba and Toronto, Ontario. The police raided the Toronto clinic that same year and charged him and his colleagues. Over the next several years, the case ascended through the court system all the way to the Supreme Court of Canada.14 In 1988, the Supreme Court came to the decision that Canada’s abortion law was unconstitutional in that it violated the woman’s right to “life, liberty, and security of the person” as provided by the Charter of Rights and Freedoms.15 There have been many attempts at a new law, but none have succeeded since the 1988 Supreme Court decision.

Current Legality

Abortion has been legal in all provinces of Canada since the Supreme Court decision in 1988.16 There are no legal restrictions on abortion; however, there are some provinces which impose regulations that may make it more difficult to obtain access to an abortion. A woman can go to either a hospital or a clinic for the procedure, which may require a referral from an OB/GYN. Additionally, procedures done in clinics may not be covered by insurance, depending on the province and whether the clinic is privately owned. Procedures done in hospitals are fully covered, the same as any other medical expense. In the 1989 case Tremblay v Daigle, the Canadian Supreme Court decided that the father of the fetus may not prevent a woman from obtaining an abortion.17

Many provinces’ health insurance will fully cover an abortion pill. This is a viable alternative option for those who, for any reason, cannot access physicians who will perform an abortion. In 2017, Health Canada approved Mifegymiso, an abortion-inducing pill which can be used at up to 9 weeks gestation.18 Manitoba, Ontario, Alberta, New Brunswick, and Quebec have all ruled to allow the Mifegymiso pill to be distributed by doctors to patients fully covered under the national health insurance.19 If the pill is not covered in the province, it will cost about C$ 300 to 350 for the two-step treatment.

United Kingdom

History

Marking a turning point from simply being a religious belief, abortion became illegal under the Infant Life (Preservation) Act 1929.20 The act criminalized the deliberate destruction of a child including those which are not yet born but are capable of being born alive. This provided detail that the earlier Offenses Against the Person Act of 1861 did not provide, stating that abortions were considered destruction of a child and were therefore murder and subject to charges pressed against the woman seeking the abortion and the provider of the abortion.21

The Abortion Act of 1967 came into place after the precedent set by the acquittal of Dr. Aleck Bourne in 1938, who stated that his interpretation of the law was that the abortion was legal because the law allows for exceptional cases where the mother’s mental or physical health is at risk, and the pregnancy is at less than 28 weeks gestation.22,23 Bourne used 28 weeks gestation because that is typically regarded as the point of growth at which a fetus can survive outside of the womb. In 1990, the Human Fertilisation and Embryology Act decreased the time restriction on abortion from 28 weeks to 24 weeks gestation. The Parliament decided that the change was necessary due to the advancement of technology. The Act also removed the restriction for late abortions from cases where the mother’s life, physical health, or mental health is at risk or in the case that there is a severe or lethal fetal abnormality.24

The Infant Life (Preservation) Act 1929 is the law that stands in Northern Ireland and prohibits most women from obtaining legal abortions without travelling to a country with less restrictions.25

Current Legality

Abortion became legal in the United Kingdom under the Abortion Act of 1967. The current gestational limit is 24 weeks and all abortion services are typically fully covered under the National Health Service (NHS). This Act only legalizes abortion under certain conditions. These include but are not limited to the following: continuing the pregnancy is harmful for the mother’s mental or physical health, if the fetus would suffer serious physical or mental handicaps when born, or if continuing the pregnancy severely affects the existing family.26 Abortions after 24 weeks are allowed if there are potentially seriously harmful mental or physical risks to the woman or fatal fetal anomalies. Abortions can be obtained in any NHS hospital with the prior verification from two doctors that the terms of the 1967 Act are met.27

The Act does not extend to Northern Ireland; thus, women must often travel to Great Britain to access abortion services under NHS.28 In Northern Ireland, the restrictions are much more limiting in that an abortion is only legal in the case where the pregnancy will result in a non-viable fetus or that the mother will die or suffer long-term harm to her physical or mental health.29 A woman in Northern Ireland may provide proof that the abortion is necessary under the current legal standings or may legally travel to Great Britain. In 2017, it was announced that the government would cover the costs of abortion for any woman travelling to England.30

Republic of Ireland

Ireland is often thought of as a secular, liberal country because of its placement in Europe; however, it is still one of the most religious countries in Europe. Policies and law in Ireland are often heavily swayed by the religious beliefs of the Roman Catholic Church.

In 1983, the 8th Amendment passed to recognize the equal right to life of the mother and the unborn child.31 This amendment gave women the right to an abortion in the case that their life is at risk, but was also the way for the judiciary of Ireland to prevent a ruling similar to Roe v Wade in America from occurring in Ireland. This amendment also clarified previous laws stating that it is a criminal offense under any circumstances to knowingly or unknowingly induce a spontaneous abortion (miscarriage).

In 1992, the 13th and 14th Amendments were added in the landmark case Attorney General v X, stating that there will be no limitation of freedom to travel outside of Ireland and no limitation of freedom to “obtain or make available [...] information relating to services lawfully available in another state.” 32,33 These amendments are especially important because they allow women considering abortion to have access to information about abortion and travel abroad if they wish to obtain an abortion. Women who are denied an abortion in Ireland often travel to England or elsewhere in Europe to obtain the abortion.

The Protection of Life During Pregnancy Act of 2013 defines the circumstances under which an abortion can be legally performed. It does not expand existing Irish abortion law, but rather puts to law the existing interpretation of the Constitution by the Supreme Court in Case X that abortion is permissible if there is a physical threat to the life of the woman, including suicide.34 Incest or rape still do not provide grounds for legal termination of a pregnancy.

Many cases since have brought the Irish abortion debate back into international public discourse. There have been several campaigns about abortion rights, #RepealThe8th being the most notable.35 On January 29, 2018 the government formally agreed to hold a referendum to repeal the 8th amendment in late May or early June 2018.36 The exact wording of the referendum and the possible changes to the existing law have not been decided yet. If the referendum passes, its implications will be felt worldwide, but especially in other countries where abortion is outlawed due to religious beliefs.

The current law is still considerably strict about the cases in which an abortion is legal. In Ireland, there are many clinics which pose as an unbiased resource for women thinking about abortion, but are actually heavily swayed by the pro-life beliefs of the Roman Catholic Church.37 Women in Ireland must be especially diligent to find a reputable clinic for information regarding abortion and the laws surrounding them.

Australia

History

While still under British rule, the colony of Australia followed the Offenses Against the Persons Act 1861 which specified that any means of intentionally inducing an abortion or miscarriage was illegal and punishable by imprisonment.38 Each state or territory has proceeded to uphold the Act, make slight changes, or repeal and replace it in its totality. The R v Davidson case that progressed through the Supreme Court of Victoria in 1969 set a precedent for the rest of Australian law concerning the conditions under which abortion should be legal.39 The result of the case, the Menhennitt ruling, made abortions legal if they were done to protect the mental or physical health of the woman. Soon after this ruling, New South Wales, Queensland, and the Northern Territory adopted or cited the rulings in cases within the respective territories.40,41

Current Legislation

Currently, each state and territory has control over their own legislation surrounding abortion. In states and territories where surgical abortion is legal, the procedure may be completely or partially covered by Medicare, Australia’s universal healthcare system.42 As of 2006, medical abortifacients may be obtained and used, and may also be covered by Medicare.43 Many believe that doctors and judiciary branch have become too relaxed on the requirements needed for a legal abortion. Most territories either do not have restrictions or do consider outside factors contributing to the woman’s mental and physical health when ruling whether an abortion is legal.

In the Australian Capital Territory, abortions are legal, and the procedure must be done by a medical doctor. In Queensland, abortion is only legal when the mental or physical health of the woman is at risk. New South Wales has the same restrictions as Queensland with the exception that social, economic, and other medical factors may be included as part of the judgement by the doctors. South Australia also has the same restrictions as Queensland with the exception that an abortion may be legal in the case of a serious fetal abnormality. Other territories have gestational limits on legal abortions44:

Because each of the territories have different restrictions on access to abortions, women across Australia must be diligent to know their own territory’s current legislation.

Poland

History

The history of abortion in Poland is heavily shaped by culture, religion, and politics, and the laws surrounding abortion changed with the state of the country. During the 16-year period between 1918 and 1932, commonly referred to as the interwar period (between World War I and World War II), abortions in Poland were illegal under any circumstances.45 In 1932, with the invasion of communist ideologies and the beginning of World War II, the law changed to legalize abortions in circumstances where the pregnancy threatened the life of the woman.45 This change in legislation also established one of the first legalizations of abortion within Europe if the pregnancy was the result of rape. This law remained untouched until 1956, when a new law was adopted that decriminalized abortions on social grounds.45 This new law came about due to the attention surrounding mortality rates from underground, often unsafe abortions, as well as the shift into the communist regime of the Soviet Union.45,46 The 1956 law required women to receive approval of two doctors before obtaining an abortion, which posed a significant barrier due to the conservative, often religious, views that lingered among doctors.47 In 1959 the Ministry of Health stepped in to ensure that women had access to reasonably obtainable abortions, interpretting the law to legalize abortions upon request.47 This produced one of the most liberal abortion laws in Europe. However, after almost 40 years with this increase in access and the end of the communist rule in Poland, abortion once again became severely restricted in 1993.48 The law was effectively reverted to a version similar to the one in place in 1932. This restrictive version is the current legislation regarding abortion in Poland.

Current Legislation

Due to the adoption of the Family Planning, Human Embryo Protection and Conditions of Permissibility of Abortion Act in January 1993 by the parliament, abortions are no longer legal on socio-economic grounds.49 Currently, there are only three circumstances under which women can legally obtain an abortion in Poland:50

The continuation of the pregnancy puts the woman’s life or health at risk

The pregnancy is the result of criminal activities, such as incest or rape

The fetus has a serious malformation

As of June 2017, emergency contraception is only available by prescription to individuals over 15 years old.51 Doctors have the right to refuse prescribing the pill, and pharmacists have the right to refuse to fill the prescription. This makes it exceedingly difficult to access emergency contraception that could prevent a pregnancy before abortion becomes necessary.

The current laws have been heavily debated over the past two decades due to the increased religiosity of the population after the end of the communist rule in 1989. Most of the recently introduced bills call for a complete ban on abortion. The most prominent demonstration that resulted from one of these bills was the Black Protest (Czarny Protest) in 2016.52 This nationwide protest was in response to a bill that proposed a complete ban on abortion, the only exception being when the woman’s life is at risk. This would have brought Poland’s laws on par with the Republic of Ireland, Malta, and the Vatican – the only three areas in Europe that are currently stricter than Poland.53 The bill was pulled just two days after the Black Protest. The 2016 bill allowed for legal action to be taken against women who obtained an abortion. In March 2018, a new bill was proposed which removed this legal ramification, but still called for a total ban on abortion.54 There was another rising of nationwide protests, and the 2018 bill was once again stopped.

Many women in Poland travel to other countries, especially Germany, to obtain abortions.55 The accumulated costs from travelling may be enough to prevent many women from getting the abortion they want or need. Women in Poland need to be especially careful when seeking out abortions, due to the high risk associated with underground abortions.

Links for information about countries not currently covered by this article:

In conclusion, access to abortion varies widely around the world. Abortion is a topic that is influenced by many societal factors including religion, current politics and culture. The policies of each country do not necessarily represent the current views and beliefs of the population, but may still result in a barrier to access to this service. Many women travel outside of their country to obtain an abortion if such a procedure is not readily available in her country and most countries have organizations which aid women in accessing the services she wants or needs.

References

Abortion Care Network

Accredidation Council of Graduate Medical Education. Clarification on Requirements Regading Family Planning and Contraception. ACGME, June 2017.

Bunreacht na hÉireann (Constitution of Ireland 1937), Article 40.3.3°.i [the right to life of the unborn]. 7 October 1983.

Bunreacht na hÉireann (Constitution of Ireland 1937), Article 40.3.3°.ii [provided that Article 40.3.3° (the right to life of the unborn) would not limit freedom to travel between Ireland and another state]. 23 December 1992.

Bunreacht na hÉireann (Constitution of Ireland 1937), Article 40.3.3°.iii [provided that Article 40.3.3° (the right to life of the unborn) would not limit freedom to obtain or make available information relating to services lawfully available in another state]. 23 December 1992.

Standish, Dominic. “From Abortion on Demand to Its Criminalization: the Case of Poland in the 1990s.” Abortion Law and Politics Today, Palgrave Macmillan, 1998, pp. 116–129.

O planowaniu rodziny, ochronie płodu ludzkiego i warunkach dopuszczalności przerywania ciąży (The Family Planning, Human Embryo Protection and Conditions of Permissibility of Abortion Act). The Council of Ministers. 7 January 1993.